Incidence and risk factors for development of venous thromboembolism in Indian patients undergoing major orthopaedic surgery: results of a prospective study

Introduction

The incidence of venous thromboembolism (VTE) in Western populations undergoing major orthopaedic surgery without any thromboprophylaxis has been reported to range from 32% to 88%. There is however limited information on incidence of VTE in Indian patients and most of the Indian patients undergoing these surgeries do not receive any form of prophylaxis regardless of their risk profile.

Methods

A prospective study was performed on 147 patients undergoing major orthopaedic surgery for total knee replacement (TKR), total hip replacement (THR), and proximal femur fracture fixation (PFF) without any prophylaxis. These patients were profiled for presence of the known risk factors responsible for development of VTE. A duplex ultrasound on both lower limbs was done 6 to 10 days after surgery. Twenty three patients underwent THR, 22 patients underwent TKR, and 102 underwent surgery for PFF. The patients were assessed clinically for any signs of deep venous thrombosis (DVT) and pulmonary embolism (PE). A helical CT scan was done in case of suspicion of PE and a duplex ultrasound was done in case of clinical suspicion of DVT irrespective of the stage of study.

Results

The overall incidence of VTE was 6.12% and that of PE was 0.6%. The risk factors that were found to be significantly responsible for development of VTE (p < 0.05) were: immobility greater than 72 hours, malignancy, obesity, surgery lasting more than two hours.

Conclusion

The study reconfirms the belief that DVT has a lower incidence in Indian patients as compared with other ethnic groups.     

Prevention of deep vein thrombosis in orthopedic surgery

In the absence of thromboprophylaxis, venous thromboembolism (VTE) affects about 50 to 80% of the patients after total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery. Since stratification of patients in those who will become symptomatic and those who will not, is not possible, primary high risk thromboprophylaxis should be provided to all patients undergoing major orthopedic surgery of the lower extremity. Various non-pharmacologic and pharmacologic thromboprophylactic measures have been evaluated. With regard to pharmacologic thromboprophylaxis unfractionated heparin has now almost completely been replaced by low molecular weight heparin (LMWH) for VTE prophylaxis. The use of acetylsalicylic acid for thromboprophylaxis in patients undergoing major orthopedic surgery of the lower extremities is not recommended. The optimal beginning of LMWH thromboprophylaxis is either 2 hours preoperatively or 6 to 8 hours postoperatively. Extended thromboprophylaxis (beyond 7 to 10 days after surgery) is recommended for high-risk patients. New antithrombotics, such as fondaparinux or (xi)melagatran, significantly reduce the risk of asymptomatic but not of symptomatic VTE compared to LMWH. In the light of other potential side effects (e.g., an increased bleeding risk) and high costs the role of these new drugs in the prophylaxis of VTE in patients undergoing major orthopedic surgery of the lower extremities remains to be established.     

Epidemiology, etiology and diagnosis of venous thrombosis

Venous thromboembolism (VTE) is one of the most frequent multifactorial diseases. It manifests clinically by deep vein thrombosis (DVT) and pulmonary embolism (PE) leading to death in about 6%. It is important to emphasize, that 50% of the patients do not present any symptoms. The prevalence is influenced by age and ethnics. Both, hereditary (Factor V Leiden, G20210A prothrombin gene mutation, deficiencies of protein C, S or antithrombin) and acquired risk factors (estrogen replacement, cancer, cardiovascular disease, surgery, trauma, immobility, use of central venous catheters, autoimmune disease such as anti-phospholipid syndrome) contribute to VTE. The risk increases dramatically by the addition of hyperhomocysteinemia or the combination of several risk factors. Since VTE is a dynamic process able to manifest clinically or to resolve completely, the identification of persons at increased risk is mainly important for early diagnosis and treatment. The diagnostic strategy including clinical scores and laboratory tests (D-dimer measurement) as initial steps to confirm the suspicion of VTE may exclude patients who do not need further, sometimes invasive imaging tests (venography, compression ultrasonography combined or not combined with colour Doppler imaging, magnetic resonance imaging). Laboratory tests for suspected inherited thrombophilia should be performed six months after clinical presentation.     

Cost-effectiveness of enoxaparin versus warfarin prophylaxis against deep-vein thrombosis after total hip replacement.

OBJECTIVE: To compare the efficacy and cost-effectiveness of enoxaparin, a low-molecular-weight heparin derivative, with that of low-dose warfarin in the prevention of deep-vein thrombosis (DVT) after total hip replacement. DATA SOURCES: English-language articles on enoxaparin and warfarin prophylaxis is patients undergoing total hip replacement published from January 1982 to December 1992. STUDY SELECTION: Four trials of enoxaparin (involving 567 patients) and six trials of warfarin (involving 630) met the following criteria: randomized controlled trial, prophylaxis started no later than 24 hours after surgery and continued for at least 7 days, warfarin dose monitored and adjusted appropriately, enoxaparin dosage 30 mg twice daily, and DVT confirmed by bilateral venography. DATA EXTRACTION: Rates of DVT, cost of prophylaxis, diagnosis and treatment per patient, rate of pulmonary embolism (PE), number of deaths and incremental cost-effectiveness (cost per life-year gained). DATA SYNTHESIS: The pooled rate of DVT was 13.6% with enoxaparin (95% confidence interval [CI] 10.9% to 16.3%) and 20.6% with warfarin (95% CI 17.4% to 23.8%). At a cost of $19.55 per day for enoxaparin the total cost per patient, including prophylaxis and management of DVT, exceeded that per patient receiving warfarin by about $121. For every 10,000 patients treated the use of enoxaparin will prevent 47 cases of DVT, 3 cases of PE and 4 deaths. Thus, the estimated incremental cost-effectiveness of enoxaparin is $29 120 per life-year gained. CONCLUSION: On the basis of current Canadian cost-effectiveness guidelines the results of this study would be considered moderate to strong evidence to adopt enoxaparin prophylaxis against DVT after total hip replacement. However, because of the limited data the estimates are uncertain. Future trials should compare enoxaparin and warfarin and incorporate a prospective economic appraisal.     

Comparison of total hip and knee joint replacement in patients with rheumatoid arthritis and osteoarthritis: a nationwide,population-based study

INTRODUCTION

Patients with rheumatoid arthritis (RA) and osteoarthritis (OA) may require total hip replacement (THR) or total knee replacement (TKR). The present study aimed to compare the demographic characteristics and medical costs of RA and OA patients from Taiwan who underwent either THR or TKR.

METHODS

The medical records of patients who had undergone THR or TKR from 1 January 1996 to 31 December 2010 were obtained from the Taiwan National Health Insurance Research Database (NHIRD). In all, we found 49 and 146 RA patients who received THR and TKR, respectively, and 1,191 and 6,574 OA patients who received THR and TKR, respectively. The gender, age, Charlson comorbidity index (CCI), hospital grade, age at registration in the catastrophic illness dataset, and medical utilisation costs of the different groups were compared.

RESULTS

There were statistically significant differences in age, CCI score, drug costs and surgery costs between RA and OA patients. Joint replacement incidence was lower in RA patients than in OA patients, and among patients who underwent THR, total medical costs incurred were higher for RA patients than OA patients. RA patients who underwent THR incurred a significantly greater total medical utilisation cost in the outpatient department (3 months before surgery and 12 months after surgery) than OA patients who underwent THR.

CONCLUSION

Analysis of Taiwan NHIRD with regard to patients who had undergone either THR or TKR indicated that RA patients were younger than OA patients, and that significantly more medical resources were used for RA patients before, during and after hospitalisation for these procedures.     

Rational thromboprophylaxis in medical inpatients: not quite there yet

Routine thromboprophylaxis in hospitalised medical patients is based on trials that predominantly use asymptomatic deep vein thrombosis (DVT) as the endpoint. As asymptomatic DVT is 10-30-fold more common than symptomatic DVT, this exaggerates estimates of benefit and cost-effectiveness. Based on symptomatic disease, the number needed to treat per venous thromboembolism (VTE) prevented is high (150-1600), and the true cost-effectiveness of thromboprophylaxis for symptomatic event reduction is uncertain. The incidence of major bleeding among patients receiving prophylaxis is at least equal to the reduction in clinical VTE. Routine thromboprophylaxis in hospitalised medical patients is not warranted, and better patient selection is needed.     

阿司匹林预防关节置换术后血栓栓塞性疾病的疗效和安全性研究

目的 探讨阿司匹林对预防人工关节置换术后静脉血栓的疗效和安全性.方法 回顾行全膝和全髋关节置换的240例患者.其中全膝关节置换157例,全髋关节置换83例.分为两组,甲组100例,于术后第1天起给予阿司匹林抗凝;乙组140例,给予低分子肝素抗凝.通过观察比较下肢深静脉血栓、肺栓塞、心脑血管意外的发生率和出血、感染的发生情况,评价阿司匹林在人工关节置换术后预防血栓栓塞性疾病的疗效和安全性.结果 甲组使用阿司匹林术后出现深静脉血栓13例(13.0%),有症状深静脉血栓7例(7.0%),疑诊肺栓塞3例(3%),心脑血管意外2例(2%);乙组出现深静脉血栓、有症状的深静脉血栓、疑诊肺栓塞和心脑血管事件分别为10例(7.1%),4例(2.9%),3例(2.1%),8例(5.7%),两组差异均无统计学意义(P值分别为0.129、0.130、0.675、0.156).阿司匹林组术后出血量、血红蛋白下降量、血肿发生率、感染发生率分别是(693±480)ml、(32.9±18.0)g/L、1例(1%)、0例(0%),LMWH组分别是(649±521)ml、(36.4±21.9)g/L、3例(2.1%)、2例(1.4%),两组之间差异均无统计学意义(P值分别为0.501、0.177、0.495、0.230).结论 阿司匹林和低分子肝素对关节置换术后静脉血栓栓塞疾病的预防疗效相近,出血和感染风险无明显区别.阿司匹林口服给药方便、费用低、患者依从性好、无需监测并对术后心脑血管事件有良好的预防作用.阿司匹林可作为人工关节置换术后预防静脉血栓常规方案之一.     

脊柱手术后并发静脉血栓栓塞症8例临床分析

目的 分析脊柱手术后并发静脉血栓栓塞症(VTE)患者的临床资料,探讨其诊断与防治方法。 方法 对宁波大学医学院附属医院脊柱外科于2010年1月-2017年12月收治的8例脊柱手术后并发VTE患者的临床表现、诊断方法、治疗过程及转归等资料进行回顾性分析,结合VTE防治的相关文献,对脊柱手术后并发VTE的流行病学、防治措施进行详细阐述。 结果 本组脊柱手术后并发VTE共8例,其中4例为单纯症状性深静脉血栓(DVT),1例为单纯症状性肺血栓栓塞症(PTE),3例为症状性PTE合并无症状性DVT,VTE总的发生率为0.47%(8/1 699)。4例单纯症状性DVT患者经抗凝及取栓、溶栓、下腔静脉滤网(IVCF)植入术等积极治疗,均治愈出院。4例PTE患者中,有1例为致死性PTE患者,经抢救无效死亡,其余3例经溶栓、抗凝等积极治疗,均治愈出院。 结论 虽然脊柱手术后VTE的发生率较低,但一旦发生后果严重,因此,应务必提高脊柱手术后VTE的预防意识,完善术前的危险因素评估,建立和完善VTE的防治体系,并进一步深化研究,改进脊柱手术VTE风险评估及分级预防模型,以便为今后脊柱手术VTE预防提供理论依据。      

在深静脉血栓—肺栓塞病程中腔静脉滤器的应用价值分析

目的：探讨腔静脉滤器(Vena cava filter VCF)在深静脉血栓(Deep venous thrombosis DVT)—肺栓塞(Pulmonary embolism PE)病程中的应用价值。方法：结合本组25例高危深静脉血栓一肺栓塞患者，对其中24例置放5种构型的永久型或临时型下腔静脉滤器(IVCF)26枚的临床疗效、影响病程与预后因素及病生理改变，复习文献分析讨论。结果：DVT有可能脱落导致PE或致死性肺栓塞；置放IVCF可有效预防肺栓塞，早期进行溶栓治疗，改变预后。结论：严格按适应证植入IVCF，对DVT—PE的早期治疗和预防致死性肺栓塞有重要意义，但其应用价值需进行综合评价和进一步探讨。     

妇科肿瘤术后并发深静脉血栓的临床研究

目的探讨妇科肿瘤术后并发深静脉血栓（DVT）的诊治及预防措施。方法分析43例妇科肿瘤术后并发DVT患者的临床资料。全部患者均经血浆D-二聚体检测井结合静脉彩超检查确诊后，采用全身或者局部抗凝、溶栓等药物治疗或手术取栓治疗，并发肺动脉栓塞（PE）患者放置临时性下腔静脉滤器（IVCF）预防致死性PE。结果29例患者临床症状明显改善，4例PE患者呼吸系统症状消失，所有患者出院复查静脉彩超示下肢深静脉有不同程度的再通。结论恶性肿瘤、老年人、肥胖是妇科肿瘤术后DVT的高危因素，血浆D-二聚体检测结合静脉彩超可协助确诊，围手术期应积极预防DVT的发生，合理应用药物、介入和手术治疗可有效防治DVT。     

Risk of Fatal Pulmonary Embolism in Patients With Treated Venous Thromboembolism

Context.— The most serious complication of deep vein thrombosis (DVT) or nonfatal pulmonary embolism (PE) is fatal PE. However, reliable estimates as to the risk of fatal PE in patients with treated DVT or PE are lacking. Objective.— To provide reliable estimates of the risk of fatal PE and the case-fatality rate of recurrent DVT or PE among patients presenting with symptomatic DVT or PE, during and following 3 months of anticoagulant therapy. Data Sources.— A MEDLINE literature search was performed to identify prospective studies in which patients with symptomatic DVT or PE were treated with 5 to 10 days of heparin and 3 months of oral anticoagulants. We searched the years 1966 to September 1997 using the search terms thrombophlebitis, diagnosis, drug therapy, and prognosis. Current Contents and bibliographies were also scanned. Data Extraction.— Of 137 retrieved studies, 25 studies satisfied predetermined methodologic criteria and were included in the analysis. Data Synthesis.— Among patients presenting with DVT, the rate of fatal PE during anticoagulant therapy was 0.4% (95% confidence interval [CI], 0.2%-0.6%); following anticoagulant therapy it was 0.3 per 100 patient-years (95% CI, 0.1-0.8). The case-fatality rate of recurrent DVT or PE during anticoagulant therapy was 8.8% (95% CI, 5.0%-14.1%); following anticoagulant therapy it was 5.1% (95% CI, 1.4%-12.5%). Among patients presenting with PE, the rate of fatal PE during anticoagulant therapy was 1.5% (95% CI, 0.9%-2.2%); following anticoagulant therapy it was 0 per 265 patient-years (95% CI, 0-3.6). The case-fatality rate of recurrent DVT or PE among patients presenting with PE was 26.4% (95% CI, 16.7%-38.1%). Conclusion.— Among patients with symptomatic PE or DVT who are treated with anticoagulants for 3 months, fatal PE is rare during and following anticoagulant therapy. Patients presenting with PE are more likely to die of recurrent PE or DVT than are patients presenting with DVT.      

Pentasaccharides. The new anticoagulants

Venous thromboembolism VTE remains a common but preventable disease. The last decade has witnessed major advances in VTE treatment and prophylaxis. Low molecular weight heparins LMWH became the agents of choice in the treatment of deep venous thrombosis DVT and are increasingly used in the treatment of stable pulmonary embolism PE. Increasing focus on simplicity and efficacy has led to the discovery of the synthetic pentasaccharides, substances that specifically inhibit factor Xa activity, producing an antithrombotic effect without affecting other coagulation factors or platelets. Fondaparinux, the first pentasaccharide introduced into the market, was first tried as a prophylactic agent against VTE in patients undergoing major orthopedic procedures, such as hip fracture, total hip and knee replacements, such approach appeared to be more effective than LMWH. Fondaparinux was also used, with promising results, in prophylaxis in patients undergoing major abdominal surgery and high risk medical patients. Pentasaccharides were recently tried in the treatment of both DVT and PE. The largest clinical investigation program ever undertaken in this therapeutic area, has shown that pentasaccharides are as safe and as effective as either unfractionated heparin UFH or LMWH, with the added convenience of once daily injection, no need for monitoring the anticoagulant effect and no major side effects such as thrombocytopenia. Therefore, the efficacy, the safety profile and the added convenience for both patients and physicians alike, will probably keep pentasaccharides as the front runner among new anticoagulants of the future. This article focuses on the use of fondaparinux as a prophylactic agent against VTE in patients undergoing major orthopedic and abdominal surgery along with high risk medical patients; it will also discuss the recent promising data on its use to treat active DVT and PE.     

Lay Stress on Study of Venous Thromboembolism

Venous thromboembolism (VTE) including deepvein thrombosis(DVT) and pulmonary embolism (PE).Its occurs in about 1 per 1 000 individuals per years.Thrombosis is a serious disorder. It may be fatal by PE(case fatality rate of venous thrombosis is estimated at1% to 2%) (Figure 1). A substantial proportion of     

Is it safe to perform operation for colorectal malignancy in Chinese patients without DVT prophylaxis? : An 8 year experience from a regional hospital in Hong Kong

Background Colorectal surgery was regarded as one of the high risk surgery for post-operative deep vein thrombosis （DVT） and pulmonary embolism. This study aimed at investigating the incidence of venous thromboembolism （VTE） after colorectal surgery for malignancy.Methods Data were collected from the prospective database of colorectal malignancy from 2000 to 2008. A total of 1421 colorectal （open and laparoscopic） operations were performed for the colorectal malignancy without DVT prophylaxis.Results Only seven patients （0.5%） developed symptomatic DVT and one of them had complication of pulmonary embolism without mortality. Open operation for colorectal malignancy was identified as possible risk factor of DVT,however, risk factors like operative time, low anterior resection, sex, age etc. were not identified.Conclusion Risk of venous thromboembolism after colorectal operation is low in Chinese of our locality and it might be safe to perform colorectal operation for malignancy without DVT prophylaxis.     

低分子肝素联合间歇充气加压预防髋、膝关节手术后静脉血栓栓塞症

目的探讨低分子肝素（low-molecular-weight heparin,LMWH）联合间歇充气加压（intermittent pneumatic compression,IPC）预防髋、膝关节手术后静脉血栓栓塞症（venous thromboembolism,VTE）的疗效和安全性。方法对53例髋、膝关节手术患者术后使用LMWH联合IPC预防VTE。其中人工全髋关节置换术18例,人工全膝关节表面置换术7例,动力髋螺钉（DHS）内固定术17例,髋臼骨折重建钢板内固定术11例。术后8h给予常规剂量LMWH,以后每24h重复使用一次,直至术后10d。同时术后当天持续使用IPC 8h,第2天起每天分2次使用,每次1h时,疗程10～14d。术后5～7d进行VTE症状评估和下肢静脉的彩超检查,并监测血小板计数及血凝,可疑肺动脉栓塞患者行CT肺动脉造影。术后1～3个月的随访中,对可疑DVT患者行第二次彩超检查。结果 53例髋、膝关节手术患者有4例出现深静脉血栓（deep venous thrombosis,DVT）,发生率为7.54%,均在出院后的3个月术后随访期内发生,伴有不同程度的下肢肿胀症状,所有患者均未出现肺栓塞（pulmonary embolism,PE）症状及严重出血并发症。国际标准化比值（international normalizedration,INR）在2.5以内,未引起血小板计数减少。结论联合使用LMWH和IPC可以显著降低髋、膝关节手术后VTE的发生率,并且具有良好的安全性。     

髋关节、膝关节置换术后静脉栓塞的风险因素分析

目的 分析髋关节、膝关节置换术后出现静脉血栓栓塞(VTE)的主要危险因素及D二聚体(D-Dimer)对VTE的诊断价值。方法回顾性分析本院收治实施单侧髋关节置换和膝关节置换手术的患者共954例,其中术后发生肺栓塞(PE)或深静脉血栓(DVT)的患者47例为VTE组,其余907例为对照组。分析两组病例资料和术后48 h的D-Dimer。结果VTE组患者吸烟史比例、手术时间、术后48 h的D-Dimer显著高于对照组,在VTE组使用硬膜外麻醉的比例显著低于对照组,吸烟史、全身麻醉、手术时间和术后48 h D-Dimer是髋膝关节置换术后发生VTE的风险因素,术后48 h D-Dimer水平的ROC曲线下面积为0.847,当D-Dimer水平为 2.175 mg/L时,其灵敏度为88.8％,特异度为84.6％。结论吸烟、全身麻醉、手术时间和术后的48 h D-Dimer水平是髋膝关节置换术后VTE发生的高危因素的风险因素,术后的48 h D-Dimer水平对术后VTE的发生有良好的预测作用。     

下肢深静脉血栓56例介入综合治疗临床分析

目的评价下肢深静脉血栓形成(DVT)的介入治疗疗效。方法下肢DVT患者56例,予以下腔静脉滤器置入及溶栓(多途径给药)、抗凝、祛聚和对症支持治疗。结果 56例患者均于治疗后2～5 d,下肢肿胀明显消退,出院复查溶栓患者大部分血管再通;出院后随访无致死性肺动脉栓塞和下肢坏死,部分患者出现深静脉血栓形成后综合征。结论介入综合治疗下肢深静脉血栓疗效确切。     

Deep vein thrombosis after total hip and knee arthroplasty in Indian patients

Background: Deep vein thrombosis (DVT) is one of the most common complications of total hip (THA) and total knee arthroplasty (TKA). Though the reported incidence of DVT is very high, that of proximal DVT is low and that of fatal thromboembolism is very low. Hence the issue of prophylaxis for DVT remains controversial. The incidence of DVT is based on various studies in European and American populations. The Asian population is genetically and socially quite different from American and European populations, and the incidence of DVT can be quite different. Therefore a prospective study was initiated at our centre to determine incidence of DVT after THA and TKA in Indian patients. Methods: A prospective study was conducted on 60 hips in 45 patients and 46 knees in 26 patients who underwent THA and TKA respectively, without any known risk factors for thromboembolic disease. DVT was studied by preoperative and postoperative serial colour Doppler ultrasonography. No prophylaxis was given to any of the patients. Results: DVT was found in two patients who had undergone THA. No case of DVT was detected in any patient who had undergone TKA. Conclusion: These results suggest that the incidence of DVT in Indian patients is very low and is not comparable with American and European populations. It is therefore not cost effective to advise prophylaxis in Indian patients undergoing THA/TKA who have no known risk factors for DVT.     

Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers,including selective clinical outcome measures

Background

With an aging society and raised expectations, joint replacement surgery is likely to increase significantly in the future. The development of postoperative complications following joint replacement surgery (for example, infection, systemic inflammatory response syndrome and deep vein thrombosis) is also likely to increase. Despite considerable progress in orthopaedic surgery, comparing a range of biological markers with the ultimate aim of monitoring or predicting postoperative complications has not yet been extensively researched. The aim of this clinical pilot study was to test the hypothesis that lower limb orthopaedic surgery results in changes to coagulation, non-specific markers of inflammation (primary objective) and selective clinical outcome measures (secondary objective).

Methods

Test subjects were scheduled for elective total hip replacement (THR) or total knee replacement (TKR) orthopaedic surgery due to osteoarthritis (n = 10). Platelet counts and D-dimer concentrations were measured to assess any changes to coagulation function. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured as markers of non-specific inflammation. Patients were monitored regularly to assess for any signs of postoperative complications, including blood transfusions, oedema (knee swelling), wound infection, pain and fever.

Results

THR and TKR orthopaedic surgery resulted in similar changes of coagulation and non-specific inflammatory biomarkers, suggestive of increased coagulation and inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in an increase in platelet (P = 0.013, THR) and D-dimer (P = 0.009, TKR) concentrations. Evidence of increased inflammation was demonstrated by an increase in CRP and ESR (P ≤ 0.05, THR and TKR). Four patients received blood transfusions (two THR and two TKR patients), with maximal oedema, pain and aural temperatures peaking between days 1 and 3 postoperatively, for both THR and TKR surgery. None of the patients developed postoperative infections.

Conclusions

The most noticeable changes in biological markers occur during days 1 to 3 postoperatively for both THR and TKR surgery, and these may have an effect on such postoperative clinical outcomes as oedema, pyrexia and pain. This study may assist in understanding the postoperative course following lower limb orthopaedic surgery, and may help clinicians in planning postoperative management and patient care.     

下腔静脉滤器在下肢深静脉血栓治疗中的应用及意义

目的探讨下肢深静脉血栓形成（DVT）患者行下腔静脉滤器（IVCF）植入的手术指征、并发症、意义及术后抗凝、溶栓治疗的必要性。方法回顾性分析2008年1月～2009年3月我院31例下肢深静脉血栓患者行下腔静脉滤器植入的临床资料,并对之随防。结果所有患者均成功将滤器置于双侧肾静脉开口平面下方,术中无严重并发症发生,术后随访6～20个月,均无症状性肺栓塞（PE）发生,1例滤器内有血栓形成,发生率为3.2%。无其他相关并发症。结论下腔静脉滤器植入可有效预防致命性肺栓塞发生,严格的手术操作及术后正规的抗凝溶栓治疗是防止滤器植入术并发症的关键。